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Doctors implicated in abuse of Iraqi prisoners

20 August 2004

By Maggie McKee

The medical community is calling for an investigation into the role of US medical staff in the prisoner abuse that took place in Iraq’s Abu Ghraib prison, according to two new journal articles and appeals from physicians’ groups.

The abuse of Iraqi prisoners in the US-run prison sparked controversy in spring 2004 when photographs surfaced showing US soldiers grinning as they posed beside naked and injured prisoners.

Now, a damning picture is emerging about what role medical staff played in the abuse.

The US military medical system “failed to protect detainees’ human rights, sometimes collaborated with interrogators or abusive guards, and failed to properly report injuries or deaths caused by beatings,” writes Steven Miles, a physician at the University of Minnesota in Minneapolis, US, in The Lancet.

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Miles, along with the journal’s editors, is calling for a full investigation of the role of medical staff after he scoured news reports and available government documents on the abuse.

Whistle blowing

Miles describes one interrogation in which medical staff left after reviving a prisoner who collapsed after a beating, allowing the abuse to continue. In another case, a medic inserted a catheter into the corpse of a detainee who died from torture to create evidence the prisoner was alive at the hospital.

And in another incident in November 2003, a surgeon listed “natural causes” as the cause of death of a man who actually died when interrogators put his head in a sleeping bag and sat on his chest. Six months later, the Pentagon ruled the death a homicide by asphyxia.

But crucially, doctors are concerned about what military medical staff did not do in an environment of physical abuse. “Where was their protest, where was their whistle blowing?” asks physician Michael Grodin, director of the law, medicine, and ethics program at Boston University, US.

He says doctors, despite their oath of care, have a long history of subverting their duties to patients in favour of other interests in “closed systems where there’s no transparency”, such as prisons. The most egregious offenders, he says, were Nazi doctors who murdered people in death camps.

“The medical community and the world at large want doctors to behave like doctors,” he told New Scientist.

Survive and evolve

Robert Jay Lifton, a psychiatrist at Harvard Medical School in Cambridge, US, discusses the dual loyalties military doctors face in a 29 July article in the New England Journal of Medicine (vol 351, p 415).

Lifton, who has written a book on the Nazi doctors, says they were able to commit murder and go about their normal lives by essentially forming a second self in a type of dissociation he calls “doubling.”

He says this trait has ironically helped humans survive and evolve, but that it can lead to adapting to violent norms in certain “atrocity-producing” situations.

He writes that Abu Ghraib is one such situation, in which “doctors and other medical personnel were part of a command structure that permitted, encouraged, and sometimes orchestrated torture to a degree that it became the norm – with which they were expected to comply.”

Various codes – from the Hippocratic Oath, to the 1975 World Medical Association Declaration of Tokyo, to the Geneva Convention – prohibit doctors from colluding in any way in torture.

“But I don’t think under current practice physicians feel they have any such obligation,” says Leonard Rubenstein, executive director of the advocacy group Physicians for Human Rights in Boston, US.

As well as calling for a full investigation of policies that led to detainee abuses, the group has drawn up a list of guidelines for medical professionals in organisations – including the military or prison service – that call for doctors to report any abuse they see and to refuse to participate in interrogations, torture, or the misuse of patients’ confidential medical records.